Manager

• Manages complex contracting and negotiations for fee for service and value-based reimbursements with hospitals and other providers.
• Builds relationships that nurture provider partnerships and seeks broader value-based business opportunities.
• Initiates and maintains effective channels of communication with matrix partners including Claims Operations, Medical Management, Credentialing, Legal, Medical Economics, Compliance, Sales and Marketing and Service.
• Contributes to the development of alternative network initiatives.
• Supports and provides direction to develop network analytics required for the network solution.
• Works to meet unit cost targets while preserving an adequate network.
• Creates and manages initiatives that improve total medical cost and quality.
• Drives change with external provider partners by assessing clinical informatics and offering consultative expertise.
• Prepares, analyzes, reviews, and projects financial impact of larger or complex provider contracts and alternate contract terms.
• Creates healthcare provider agreements that meet internal operational standards and external provider expectations.
• Ensures the accurate implementation, and administration through matrix partners.
• Assists in resolving elevated and complex provider service complaints.
• Researches problems and negotiates with internal/external partners/customers to resolve highly complex and/or escalated issues.
• Manages key provider relationships and is accountable for critical interface with providers and business staff.
• Responsible for accurate and timely contract loading and submissions.

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